A retrospective study of the culture and sensitivity pattern of urinary tract infection causing organisms at RIMS teaching Hospital, Raichur, India

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The objective was to assess the distribution of urinary tract bacterial pathogens and to determine the antibiotic susceptibility profile of the isolates in our setting. Single positive cultures with a colony count of >105 CFU on CLED medium were identified and their antibiotic sensitivity and resistance profile was depicted in the form of an antibiogram.

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Nội dung Text: A retrospective study of the culture and sensitivity pattern of urinary tract infection causing organisms at RIMS teaching Hospital, Raichur, India

Int.J.Curr.Microbiol.App.Sci (2017) 6(10): 1530-1536 International Journal of Current Microbiology and Applied Sciences ISSN: 2319-7706 Volume 6 Number 10 (2017) pp. 1530-1536 Journal homepage: http://www.ijcmas.com Original Research Article https://doi.org/10.20546/ijcmas.2017.610.183 A Retrospective Study of the Culture and Sensitivity Pattern of Urinary Tract Infection Causing Organisms at RIMS Teaching Hospital, Raichur, India R. Venkatesh Naik*, Basavaraj V. Peerapur and P. Sandhya Department of Microbiology, RIMS, Raichur, Karnataka, India *Corresponding author ABSTRACT A retrospective study was done and culture and sensitivity reports were collected from RIMS, Teaching Hospital, Central Laboratory Microbiology Department, Raichur for a period of Sep 2014 to April 2016 were analysed. A total of 351 urine samples collected during a time period of 20 months from September 2014 to April 2016 and fulfilling the inclusion criteria were included in the study. The objective was to assess the distribution of urinary tract bacterial pathogens and to determine the antibiotic susceptibility profile of the isolates in our setting. Single positive cultures with a colony count of >105 CFU on CLED medium were identified and their antibiotic sensitivity and resistance profile was depicted Keywords in the form of an antibiogram. Out of 351 urine samples 217(61.8%) urine samples were Urinary tract culture positive with significance. 57.1% of the total isolates were identified as E. coli, infections, E.coli, followed by Pseudomonas spp. 16.1%, Klebsiella pneumonia 9.6%, Proteus spp 4.6%, Antimicrobial Citrobacter spp 4.1%, Staphylococcus aureus 4.6%, Coagulase negative Staphylococcus resistance. 2.3% and Candida spp 1.4%. Among 199 gram negative organism isolated it was observed that 198/199(99.4%) of total tested isolates were sensitive to Imipenem followed by Article Info Piperacillin/Tazobactam 170/199(85.4%), Cefoperazone/sulbactam 128/199(64.3%), Accepted: Ceftazidime 112/199(56.2%), Augmentin 107/199(53.7%), Amikacin 105/199(52.7%), 14 September 2017 Nitrofuration 101/199(50.7%), Cefipime 100/199(50.2%), Ceftriaxone 95/199(47.7%), Available Online: Gentamicin 90/199(45.2%), Nalidixic acid 75/199(37.6%), Levofloxacin 70/199(35.1%), 10 October 2017 Ciprofloxacin 48/199(24.1%), Cotrimoxazole 28/199(14.1%). Also out of 18 gram positive organisms isolated 3 were Candida species. Sensitivity profile of gram positive organisms showed Vancomycin was most susceptible 18/18(100%) followed by Augmentin 14/18(77.7%), while Penicillin was least susceptible 4/18(22.2%). This is an alarmingly low sensitivity to Ciprofloxacin, Cotrimoxazole and Penicillin which is routinely used as empirical therapy for uncomplicated community acquired urinary tract infections and other infections. There is need for proper sensitivity testing to guide the management of UTIs with hospital antibiotic policies. Introduction Urinary tract infections (UTIs) are one of the each year.[4] UTI can be caused by different most common bacterial infections in humans microorganisms including bacteria, protozoa, both in the community and hospital setting. [1– parasites, fungi and viruses are the major 3] UTI remains second most common causative organisms. Among these bacteria infectious disease and approximately about account for more than 95% of UTI cases. [5] 150 million people were diagnosed with UTI E. coli is the most common isolate 1530
Int.J.Curr.Microbiol.App.Sci (2017) 6(10): 1530-1536 responsible for UTI.[6-9] Other important Sample preparation and microscopy pathogens are Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus The collected urine sample was prepared for aureus.[10, 11] Distribution of uropathogens and microscopy according to standard method. their susceptibility to antibiotics is variable The urine samples were mixed and aliquots regionally[7,12], so it becomes necessary to centrifuged at 5000 rpm for 5 min. The have a knowledge of distribution of deposits were examined using both 10X and uropathogens and their susceptibility to 40X objectives. Samples with ≥ 6 white blood antibiotics in a particular setting. cells/mm were regarded as pyuric.[15] Antimicrobial resistance is a growing problem and a cause of major concern in many Media preparation countries.[13] This study is aimed to determine the distribution of bacterial uropathogens and The media used were Blood Agar (BA), their susceptibility to antimicrobials in Nutrient Agar (NA) and Cysteine Lactose patients who attended outpatient and inpatient Electrolyte Deficient (CLED) Agar were from various departments of RIMS, Teaching prepared according to the manufacturer’s Hospital, RAICHUR, Karnataka from instructions. September 2014 to April 2016. Sample culturing Materials and Methods The collected urine samples were processed This was a retrospective study conducted at for culture and report according to standard RIMS, Teaching Hospital, Central Laboratory method procedure and protocol. For the visual Microbiology Department, RAICHUR, examination and calibrated Loop Streak Karnataka. The data of all cases with urine method for urine culture performed 1 μl wire culture positive reports were analysed from loop was sterilized and dipped of into urine Sep 2014 to April 2016. Over the course of sample. The loop was then streaked on the study, total of 351 urine samples were plate of Cysteine Lactose Electrolyte collected. Out of those 351 successful Deficient (CLED) Agar. The plates were samples 176 females and 175 males and were incubated over night at 37°C for 24 to 48 in the age group of 1 to above 60 years old. hours. Following the appearance growth well- There were higher numbers of samples isolated bacterial colonies were processed for collected from the extreme of ages 1-9 years antibiotic sensitivity and biochemical tests.[16] and above 60 years (Table 1). Identification of microorganisms Collection of urine specimen All bacterial isolates were characterized on The specimens were collected into sterilized, the basis of colony morphology, Gram wide necked, leak proof, plastic universal staining, Catalase test, Coagulase test, and containers. Clean-voided mid-stream urine oxidase tests. From the results of preliminary specimens were collected. Each of the study identification test the gram negative rods were participant was instructed on the mode of subjected to the following routine collection of the mid-stream urine that was biochemical tests such as mannitol motility during forceful urination after the first 10 -20 test, indole production, urease production, ml has been voided.[14] citrate utilization test and Triple sugar iron reaction.[17] 1531
Int.J.Curr.Microbiol.App.Sci (2017) 6(10): 1530-1536 Sensitivity test above 60 years old showed high risk of infections due to bladder outlet obstruction in All isolated organisms were tested against older men there might be bacterial prostatitis various antibiotics in vitro, antibiotic and non-bacterial prostatitis. For the age susceptibility was tested in laboratory by disc group 30-39 years again females showed diffusion method[18] on Muller Hinton Agar higher risk of infections than males because by Kirby-Bauer method[18] using the younger females represented complication of following antibiotic discs, Imipenem, sexually transmitted urethritis. However, in Piperacillin/Tazobactam, Cefoperazone/ 10-19 years age groups both males and sulbactam, Ceftazidime, Augmentin, females samples there were a slight difference Amikacin, Nitrofuration, Cefipime, of positive and negative samples. Both the Ceftriaxone, Gentamicin, Nalidixic acid, extremes of age groups have risk of UTIs Levofloxacin, Ciprofloxacin, Cotrimoxazole, infections due to low immunity (Table 2). Vancomycin, Novobiocin, Penicillin, Erythromycin and Tetracycline accordingly. Out of total 351 collected samples 134 samples showed no growth on culture plates. Statistical analysis 217 were positive samples. Pathogenic microbes were isolated from 217 positive The data were entered and analysed using samples (61.8%) which in the vast majority of Statistical Package for Social Sciences SPSS cases E. coli (57.2%) followed by software version 21.0. P - Value < 0.05 was Pseudomonas (16.1%) and Klebsiella species considered statistically significant. (9.6%) were among the most frequent uropathogen bacteria. That was similar to Results and Discussion other studies where it was the most frequent pathogen causing UTI as studied by Mehar Out of total collected 351 successful samples where 62.6% cultures grew E. coli 16 and 176 females and 175 males and were in the 66% E. coli studied by Naeem in Islamabad17. study group of 1 to above 60 years old. There were higher numbers of samples collected Those results were also similar with a study from the extreme of ages 1-9 years both conducted by Dilnawaz in 2005 in India males/females (23.5%)/(20.5%) and above 60 which reflects that first two common years both males/females (20.6%)/(24.5). In organisms were E. coli and Klebsiella age groups of 20-29 years and above 60 years pneumoniae 18; but in this study first two there were higher numbers of negative common organisms were E. coli and samples of males and females respectively Pseudomonas sps. In our study most of cases showing no growth on culture plates. That of UTI were caused by gram negative could be due to indiscriminate consumption organisms (91.1%), in which female case of non-prescribed antibiotics by the peoples prevalence was high, similar to other studies whenever difficulty in urination was noticed. (Table 3). UTIs were higher in numbers of females than males in age group of 1-9 years because of Consequently higher prevalence of gram continuous wetting and due to difficulty in negative organisms might be due to fecal keeping dry under wears and may be due to contamination, the predilection of the short distance between vagina and anus which organisms from the toilets and the shortness make easy excess of pathogens in female of the female urethra in females. That urinary tract. The male positive samples prevalence however was also reported in 1532
Int.J.Curr.Microbiol.App.Sci (2017) 6(10): 1530-1536 earlier works by Smith in Australia.[19] There CONS which was a member of skin flora was also a possible link between the might stay on the skin and get transmitted prevalence of UTI among population and the during sexual intercourse. On examination of level of personal hygiene or the state of toilet demographic state of the cases by age, it was facilities. Sexual activity was another feature observed that both the extremes of age groups that predisposes population to UTI. For have risk of UTIs. example Staphylococcus aureus (4.6%) and Table.1 Showing age and gender wise distribution of study participants Age groups Males Females Total (years) No. (Percentage) No. (Percentage) No. (Percentage) 1-9 41 (23.5) 36 (20.5) 77 (22.0) 10-19 30 (17.1) 22(12.5) 52 (14.8) 20-29 31 (17.7) 30 (17.0) 61 (17.4) 30-39 10 (05.7) 20 (11.4) 30 (08.5) 40-49 10 (05.7) 10 (05.6) 20 (05.7) 50-59 17 (09.7) 15 (08.5) 32 (09.1) >60 36 (20.6) 43 (24.5) 79 (22.5) Total 175 (100) 176 (100) 351 (100) Table.2 Showing age and gender wise distribution of positive and negative samples of study participants Age groups Positive samples of Negative samples of Positive samples of Negative samples of (years) Males No. (% age) Males No. (% age) Females No. (% age) Females No. (% age) 1-9 22 (22.4) 19 (24.7) 32 (26.9) 04 (07.0) 10-19 15 (15.3) 15 (19.5) 10 (08.4) 12 (21.0) 20-29 07 (07.2) 24 (31.2) 20 (16.8) 10 (17.6) 30-39 09 (09.2) 01 (01.3) 19 (16.0) 01 (01.8) 40-49 08 (08.2) 02 (02.5) 04 (03.3) 06 (10.5) 50-59 16 (16.3) 01 (01.3) 08 (06.7) 07 (12.3) >60 21 (21.4) 15 (19.5) 26 (21.9) 17 (29.8) Total 98 (100) 77 (100) 119 (100) 57 (100) Table.3 Showing percentage of isolation of microbes from UTIs Organisms Isolated Males (%) Females (%) Total (%) E. coli 48(57.8) 76(56.8) 124(57.2) Pseudomonas Sps 14(16.9) 21(15.7) 35(16.1) Klebsiella Sps 10(12.0) 11(8.2) 21(9.7) Proteus Sps 04(4.8) 06(4.5) 10(4.6) Citrobacter Sps 03(3.6) 06(4.5) 09(4.1) Staphylococcus aureus 03(3.6) 07(5.2) 10(4.6) Coagulase negative Staphylococcus 01(1.2) 04(2.9) 05(2.3) Candida Sps 00(0.0) 03(2.2) 03(1.4) Total 83 134 217(100) 1533
Int.J.Curr.Microbiol.App.Sci (2017) 6(10): 1530-1536 Table.4 Percentage susceptibility of Gram negative isolates of UTIs Antibiotics Susceptibility Percentage Imipenem 198/199 99.4% Piperacillin/Tazobactam 170/199 85.4% Cefoperazone/ Sulbactam 128/199 64.4% Ceftazidime 112/199 56.2% Augmentin 107/199 53.7% Amikacin 105/199 52.7% Nitrofurantion 101/199 50.7% Cefipime 100/199 50.2% Ceftriaxone 95/199 47.7% Gentamicin 90/199 45.2% Nalidixic acid 75/199 37.6% Levofloxacin 70/199 35.1% Ciprofloxacin 48/199 24.1% Cotrimoxazole 28/199 14.1% Table.5 Percentage susceptibility of Gram positive isolates of UTIs Antibiotics Susceptibility Percentage Vancomycin 18/18 100% Augmentin 14/18 77.7% Nitrofurantion 13/18 72.2% Novobiocin 13/18 72.2% Tetracycline 12/18 66.6% Erythromycin 12/18 66.6% Ciprofloxacin 12/18 66.6% Nalidixic acid 12/18 66.6% Gentamicin 12/18 66.6% Cefotaxime 11/18 61.1% Cefoperazone 11/18 61.1% Penicillin 4/18 22.2% Antibiogram in our study showed that drug for gram positive bacteria. Those Imipenem and Piperacillin/Tazobactam were antibiotics are still effective for treatment of most susceptible drugs for UTI infection urinary tract infections. The majority of while Ciprofloxacin and Cotrimoxazole antibiotics tested according to tables 4 and 5 showed least susceptibility for the isolates, resistance of uropathogens against majority of which is alarming because these drugs are commonly used antibiotics increased. The used as empirical treatment for UTI (Table 4). implication of that was the possibility of easy access causing self-medication, misuse and Vancomycin and Augmentin were most abuse, leading to the development of effective antibiotics for isolated gram positive resistance. The selection of antibiotic against bacteria, while Penicillin is most resistant any urinary tract pathogen depends on the 1534
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